LCD ID number: L36342 (Florida/Puerto Rico/U.S. Virgin Islands) After review of the local coverage determination (LCD) for screening and diagnostic mammography, it was determined to retire the LCD based on national coverage determination (NCD) 220.4. Therefore, the related coding guideline article is also being retired. Effective date: The retirement of this LCD and related coding…
This recurring update notification provides the availability of payment allowances for the seasonal influenza virus vaccines as updated on an annual basis, effective August 1 of each year. The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia…
Outpatient Laboratory Claims: Referring Practitioner Required In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers. Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical…
Aetna will no longer allow payment for below mentioned services, Effective from December 1, 2019. H2021 — community-based services, per 15 minutesH0032 — mental health service plan development by non-physicia Reference: Behavioral Health services Updates
HCPCS Code J1740 (Boniva) 733.01 Senile osteoporosis733.09* Other osteoporosisE932.0* Adrenal cortical steroids causing adverse effects in therapeutic use *When reporting ICD-9-CM code 733.09, the ICD-9-CM coding manual requires a dual diagnosis. In this regard, when reporting ICD-9-CM code 733.09 (other, osteoporosis), ICD-9-CM code E932.0 (adrenal cortical steroids) must also be reported. HCPCS Code J3487 (Zometa)…
CPT G0010 Administration of hepatitis B vaccineThe Centers for Medicare & Medicaid Services (CMS) retroactively assigned HCPCS code G0010 to APC 0436, Level I, Drug Administration,and changed the status indicator for HCPCS code CPT G0010 from status indicator “B” to status indicator “S” effective January 1, 2011.Effective for claims processed with dates of service on…
The timeframe for coding an acute MI in ICD-10 is 4 weeks. The ThinPrep Pap Test is the only pap test that is FDA-approved as “significantly more effective” at detecting precancerous cervical cells. Hospital neither need to follow 1995 nor 1997 documentation, Each facility must design its own documentation guidelines, based on principles outlined in…
The CMS HCPCS Quarterly Update includes two new codes (Q2048 and Q2049) for liposomal doxorubicin that will become effective July 1, 2012. The code descriptors are worded in a manner that distinguishes Lipodox and Doxil. As of Sun July 1, HCPCS code J9001 – Doxorubicin HCl, all lipid formulations, 10 mg will not be used…
Theraskin can be reported with the Q4121 CPT code and billed per square centimeter. Documentation and medical necessity is required. Q4121 Theraskin Description Theraskin is reported with code Q4121. It is defined as: “TheraSkin®, per square centimeter.” TheraSkin® is a biologically active cryopreserved real human skin allograft with both epidermis and dermis layers. TheraSkin provides,…
CMS may exempt individual eligible professionals and group practices participating in the eRx GPRO from the 2013 payment adjustment if it is determined that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship. Hardship Exemption Circumstances and Codes: Inability to electronically prescribe due to state, or federal law,…
